Archive for the ‘Anthem Blue Cross Blue Shield’ Category

There have been health insurance exchanges in California for decades, something that much of the country is just starting to understand now. Since 1996, CaliforniaChoice has been operating a private health insurance exchange in California. They are the most successful small group private insurance exchange, serving 150,000 individuals and more than 10,000 employers in the state. This information comes from CaliforniaChoice’s press release “CaliforniaChoice Welcomes Covered California Into the Health Insurance Exchanges Market.” In addition to their other members, Covered California has now joined this private health insurance exchange. This is good news for California residents looking for health insurance because more competition, be it in private or public health insurance exchanges, benefits the general public.

CaliforniaChoice has many things to offer in addition to health insurance. They provide dental, vision, life insurance, and chiropractic care options. For no cost, they also give added value in the form of employee discounts and online human resources support. Some of the providers in CaliforniaChoice’s exchange include Health Net, Aetna, Kaiser Permanante, Anthem Blue Cross, Sharp Health Plan, and Western Health Advantage. Covered California includes options from some of these insurers as well as others. They also just announced last week the carriers that are going to be part of their new Small Business Health Options Program (SHOP) marketplace.

The success of both public and private health insurance exchanges lies in a combination of great choices for consumers and excellent customer service availability. In addition to that, qualified brokers are the cornerstone of CaliforniaChoice for their expertise and unbiased information. Their plans are only sold through brokers. Small businesses aren’t currently penalized for not offering health insurance or forced to join Covered California’s SHOP program, but rules are changing for some employers when the full Affordable Care Act takes effect. But as attention to health insurance and exchanges in particular increases across the United States, CaliforniaChoice hopes that more employers will realize that they can offer affordable health insurance to their employees and increase quality of life.

There’s an ongoing debate over whether more or less regulation of the health insurance industry will help to lower customers’ premiums. The Boston Globe published Julie Appleby of Kaiser Health News’ article, “Loosening health insurance rules in Maine has produced mixed results after 6 months.” Last year, health insurance regulations in Maine changed in an attempt to reverse the fact that they have some of the highest health insurance premiums in the United States. The promises given to Maine residents with this legislation were that everyone’s premiums would decrease and that more health insurance companies would enter the market to increase competition. After six months, a little bit has changed, but not much.

No new health insurance companies have entered into Maine’s marketplace, hopefully some will with more time, but they haven’t yet. And while people under the age of 40 did see lower health insurance rates across the board, older people mostly saw rate increases. About half of individuals saw health insurance increases averaging 1.7%, but as high as 18%. An insurance consultant said that regulations are not about lowering overall premiums, but making insurance premiums more fair. This tends to lower rates for the young and increase rates for the old, since health insurance costs tend to increase the older people get.

Maine’s regulators made three large changes six months ago. They allowed insurers more freedom to vary premiums, gave them the ability to issue rate increases of less than 10% without state approval, and made a “reinsurance” fund that is meant to protect insurers from the costliest medical bills. Anthem Blue Cross and Blue Shield, the top insurer in Maine, increased the rates of 54% of their policyholders. They do have 3.5 times more clients over the age of 55 than they do under the age of 40. Around 10% of small businesses saw their rates go down compared to 3% before the changes, but that means that 90% did not. Some experts do believe that even those who saw rate increases had lower increases than they would have before Maine’s new regulations.

Many of the new regulations in Maine mimic changes that are likely to occur soon from the Affordable Care Act. There is a good chance that we will see some similar results nationally, but there will be help in the form of subsidies to help some people pay for their health insurance costs. Six months is too soon to make a declaration of success or failure with this program, but we’ll continue to watch it closely.

While the fighting over the individual mandate in President Obama’s Affordable Care Act of 2010 rages on, recent court rulings have upheld the mandate. The Insurance Journal article “U.S. Judge Upholds Individual Mandate in Obama Healthcare Law” discusses an October ruling from U.S. District Judge George Steeh. The individual mandate will go into effect in 2014 and requires all Americans to compare health insurance and get coverage or risk getting penalized by the government.

Conservative interest groups and Republicans in general are up in arms over the new law and are trying to get it changed before it is scheduled to go into effect. The Thomas More Law Center’s lawsuit filed in Michigan argued that the individual mandate is unconstitutional because of the tax on Americans and that it is above and beyond Congress’ powers. Judge Steeh disagreed, however, and said that the mandate is within Congress’ power based on the Constitution’s Commerce Clause and confirmed that penalizing Americans who do not follow the law is also within their authority.

Out of six claims filed by the Thomas More Law Center, two were dismissed by Judge Steeh and the other four are pending. Steeh also rejected the injunction that they wanted to issue against the government. He said that the minimum coverage provision has been put in place to help take care of skyrocketing health care costs and get more Americans covered under health insurance from Anthem Blue Cross Blue Shield and other insurers. The Thomas More Law Center surely is not the only group fighting the government over this healthcare reform bill. Many states have joined a lawsuit in Florida challenging the individual mandate as well.

Anthem Blue Cross Blue Shield had rate increases approved by the California Department of Insurance. Rate increases average 14% for Anthem Blue Cross and 19% for Blue Shield of California, although Anthem was hoping to get approval for rate increases up to 39%. The public was outraged over those potential rate hikes so the government stepped in to regulate a lower increase. Anthem is the largest health insurer in California for-profit, but their proposal for the rate increases was found to have accounting errors so it was withdrawn.

President Obama used Anthem’s proposed rate increases as an example of what is flawed in our health care system. Consumers should save around $184 million with the lowered rate increases, according to the Department of Insurance. When you compare health insurance increases by insurers like the nonprofit Blue Shield of California, the insurer says that they have no choice because they are paying that much money out to hospitals, doctors and others for claims. Both insurers were found to follow the State’s rule that 70% of their income be used to cover actual medical treatment. Anthem is required to give at least 30 days notice before increasing their customers’ policy costs.

Individual health insurance rates have increased by as much as 20%, compared with employer-sponsored group plan increases closer to 5%. In the Associated Press article “Survey: Individual health insurance premiums jump,” Tom Murphy summarizes the results found in the Kaiser Family Foundation’s new survey. Although individual insurance plans increased by 20%, consumers were able to compare health insurance rates at other providers causing many to switch. Switching providers lowered the average price increase to 13%, still much higher than the employer-sponsored family plan increase of 5%. Individual employer-sponsored plans stayed almost the same from year to year.

The individual health insurance market is used by 14 million or so Americans under the age of 65, while 157 million participate in employer-sponsored plans. Anthem Blue Cross Blue Shield of California came under fire last year for their request of 20% premium increases, but they argue that the increases are fully necessary. All of these individual health insurance increases most likely added to the health care reform debate and the bill that was passed in March. Almost half of the people surveyed purchase individual health insurance because they are self-employed or own small businesses. We’ll see what the health care changes bring about for the individual market’s costs.

The laparoscopic sleeve gastrectomy is a new weight loss procedure available to treat obesity and diabetes. According to “Insurers Divided Over Experimental Stomach Surgery to Treat Obesity,” Matthew Sturdevant of The Hartford Courant says that some insurers are not covering the procedure while others are. The procedure has the same goal as gastric bypass and gastric banding. It shrinks the stomach to 15% of the original size so that you eat less. Fallon health insurance and other insurers have had to make a tough decision whether or not to cover the newer procedure. Some companies believe that more research should be done, while others are already covering the costs to help avoid the other long term costs related to obesity and diabetes.

UnitedHealthCare and Aetna decided to cover the sleeve gastrectomy at a cost of $16,000-$25,000 for the procedure. CIGNA Corp. and Anthem Blue Cross Blue Shield of Connecticut are not covering the procedure currently because they believe it is experimental and needs more research to be proven effective and safe. The sleeve gastrectomy procedure turns the shape of the stomach into a sleeve rather than the natural kidney bean shape. It is deemed better than gastric bypass by some people because it doesn’t skip over the small intestine where important nutrients are absorbed. The benefit over gastric banding is that you don’t have to have repeat surgeries like you do to adjust the gastric band. Some advocates believe that the sleeve gastrectomy pays for itself in about two years because of the obesity related health costs that are avoided.

Under President Obama’s new health care plan, health insurance companies will be required to insure adult children for a longer time period come September of this year. Anthem Blue Cross Blue Shield has implemented that practice ahead of the deadline, according to “Blue Cross Blue Shield Does the Right Thing” on Fav Stocks. This information comes from White House Communications Director Dan Pfieffer. With May and June being the top months for college graduation, many parents and young adults are thrilled with this health insurance development. Young adults were traditionally kicked off of their parents health insurance plans upon graduation or age 23 if they were still in college.

The age has been increased as well as the college stipulation modified with President Obama’s new plan. Since many recent college graduates and young adults get starting jobs that don’t include health insurance, staying on their parents’ insurance a bit longer keeps them from going without coverage. Secretary Sebelius sent letters to major health insurers asking them to implement this policy before the deadline and the White House is pleased with the response. They are proud of how many insurance companies have chosen to “do the right thing” for eligible customers. Kaiser Permanente, United Health, Wellpoint, and Humana are some of the others who have implemented the changes ahead of September’s deadline.

In the Medical News Today article “Health Insurance Customers in California, Mass. Await Decisions About Premium Increases,” they discuss insurance customers’ hopes that their premiums will not be going up. Anthem Blue Cross Blue Shield, the largest for-profit health insurer in California, has plans to increase health insurance premiums by as much as 39% in California and Massachusetts. After announcing the plans, there was an uproar from the the public citizens who purchase individual health insurance from Anthem Blue Cross. Because of the public outrage, California insurance commissioner Steve Poizner appointed outside actuary Axene Health Partners to evaluate the company’s spending practices.

While Anthem is probably none too thrilled with this process, they have no choice but to wait. May 1 is the date that Anthem agreed to wait for after a two month stall of their rate hikes. Many of the company’s 800,000 individual policyholders will see their premiums increase if Axene Health Partners’ report shows no misconduct on the books of Anthem Blue Cross. The report should be available and a determination made in approximately two weeks. Until that time, individual insurance policyholders with Anthem Blue Cross Blue Shield wait on baited breath to see if their health care costs are going to skyrocket.

The Washington Post article “Who is left uninsured by the health-care reform bill?” by Ezra Klein contains intriguing information. With two different pie charts showing the number of uninsured Americans both with and without the health-care reform bill, we are better able to compare health insurance coverage both ways. The first chart shows the breakdown of insurance coverage in 2019 without the recently passed health-care reform bill. Uninsured Americans would make up the second largest group of 54 million people. The largest segment would belong to those insured through the employer market by companies like Anthem Blue Cross Blue Shield. Thirty-five million people would have insurance through Medicaid or the Children’s Health Insurance Program (CHIP) while the remaining 30 million Americans would be covered under other non-group plans. Compare the number of Americans uninsured without this health-care reform to the number forcasted with the bill’s passing.

Uninsured Americans should move from the second largest category to the smallest group with the passage of this health-care reform act. Employer market plans will remain the largest group with 156 million people, followed by 44 million on Medicaid or CHIP, 25 million in the other/non-group market with smaller companies like Golden Rule Health Insurance, 24 million in the created exchanges, and 22 million in the smallest category of uninsured. Many skeptics ask why so many Americans would still be uninsured with the passage of the health-care reform bill. The majority of those uninsured would actually be illegal immigrants who are not eligible for insurance coverage through the new program. The other people that make up the uninsured category would be those who choose not to carry coverage in lieu of paying the $750 penalty, those whose income is low enough that they are not required to purchase insurance, and people who qualify for public programs like Medicaid but don’t actually sign up. The bottom line is that only 40 million Americans will be in a different health insurance situation after the health-care reform bill and 75% of those will go from being uninsured to being insured. Most of the others will have moved from individual or small group coverage into the insurance exchanges.

Consumers in at least four states have seen their health insurance premiums skyrocket, according to “Individual insurance rates soar in 4 states” from the Associated Press. The article applies mostly to consumers that purchased their own individual health insurance, either because they didn’t have any from an employer or they found better rates when they went to compare health insurance at the individual versus the company level. Anthem Blue Cross Blue Shield in California plans to raise its individual policyholders’ rates by up to 39% at the beginning of next month. In Maine, Anthem Blue Cross plans up to 23% increases this year, after increasing rates 32% last year.

Many insurance companies in Oregon plan to raise rates by up to 15% after a majority of the individual plans increased by 25% last year. Unfortunately premiums are much more volatile for consumers who hold individual insurance policies because they can’t get the group discounts allowed to employers and other large groups. It is predicted that individual insurance rates will increase in the short term by up to 30% across the board. Without any kind of meaningful health care reform happening at the federal level, states will most likely start the legislative process of helping their consumers. Companies like Golden Rule Insurance work to give you affordable health care in a climate with seemingly outrageous increases. While insurance companies defend the increases and say they are necessary, the best that individuals can do right now is shop around for the best health insurance for them and contact the government to get involved in legislation.